Older individuals who participate in activities that keep their brains sharp may delay the rapid memory decline of preclinical dementia, researchers found.

Action Points

Explain to interested patients that this study found an association between remaining cognitively active and delays in the onset of memory declines preceding dementia.

Point out that the researchers did not address whether increasing participation in cognitively stimulating exercises would result in the delays.

Older people who participate in activities that keep their brains sharp may delay the rapid memory decline of preclinical dementia, researchers found.

For each additional activity day spent reading, writing, doing crossword puzzles, playing board or card games, having group discussions, or playing music, older individuals who eventually developed dementia delayed the onset of accelerated memory decline by more than two months (P=0.016), according to Charles Hall, PhD, of Albert Einstein College of Medicine in New York City, and colleagues.

However, those who had high levels of participation in cognitive activities had faster rates of memory decline after they developed dementia, the researchers reported in the Aug. 4 issue of Neurology.

Gary Small, MD, director of the UCLA Center on Aging, commented that the findings were “consistent with many previous studies supporting the possible brain-protective effects of cognitively stimulating activities.”

The study follows another by Hall’s group that found increased education was also associated with a delay of the onset of memory decline.

Although the results have been consistent, Samuel Gandy, MD, PhD, of Mount Sinai School of Medicine in New York City, said that the real test will be a a clinical trial involving various cognitive exercises.

Only then, he said, will researchers be able to determine whether the early and later cognitive activities actually protect cognitive function or whether they just act as reporters of intact cognitive function.

Hall and colleagues theorize that stimulating activities and increased education are related to cognitive reserve, which allows the brain to compensate for neuropathologic damage up to a threshold, according to the researchers.

Building up this reserve could delay the rapid memory declines seen in the preclinical stages of dementia, they said.

To explore the issue, Hall and his colleagues turned to the Bronx Aging Study.

The current analysis looked at 488 older individuals (mean age 79.5) who did not have dementia at baseline.

At baseline, subjects were interviewed about participation in six leisure time cognitive activities (reading, writing, crossword puzzles, board or card games, group discussions, or playing music). They coded self-reported frequency of participation to generate a scale on which 1 point corresponded to participation in one activity for one day per week.

During follow-up, 101 developed dementia, with a mean time to diagnosis of five years. The most common diagnosis — in 47 — was possible or probable Alzheimer’s disease.

On average, these individuals participated in at least one of the six activities at least one day a week.

For each additional activity day, the onset of accelerated memory loss — as measured with the Buschke Selective Reminding Test — was delayed by about 66 days (P=0.016).

Individuals who participated in 11 activity days per weekhad a delay of 1.29 years compared with those who participated in four.

Once the memory decline started, however, the rate accelerated as the number of activity days increased (P=0.004).

The inclusion of education did not have a significant effect on the analysis.

“One possible explanation is that the effect of early-life education is mediated through late-life participation in cognitively stimulating activities,” the researchers said.

“A second possibility,” they continued, “is that reserve could be primarily the function of late-life cognitive activity, with education simply a marker that is both easier to measure and a predictor of late-life activity.”

Or perhaps, they said, the study was underpowered to assess the joint effects of cognitive exercise and education.

“Nevertheless,” they concluded, “the effect of participation in cognitive activities seems to be at least somewhat independent of education, suggesting that engagement in cognitive activities in late life might maintain cognitive vitality regardless of baseline educational attainment.”

The authors acknowledged some limitations of the study, including self-reported assessments of leisure activity at a single time point.

The study was supported in part by a program project grant from the National Institute on Aging (NIA). Original data collection for the Bronx Aging Study was funded by grants from the NIA and the National Institute of Neurological Disorders and Stroke (NINDS).

Dr. Hall serves on the editorial board of The Open Neurology Journal, has received honoraria for serving on peer-review panels for the National Cancer Institute, the Breast Cancer Research Program, Congressionally Directed Medical Research Programs, the U.S. Army Department of Defense, the National Institute of Child Health and Human Development, and the NIA.

He has also received salary support from the NIH, the Department of Defense, and the National Institute of Occupational Safety and Health, and he receives research support from the Breast Cancer Research Foundation, the American Cancer Society, and the NIH, and is a member of the American Statistical Association Media Experts List.

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